Contraception: X最新文献

{"title":"An exploratory survey regarding the Maryland Contraceptive Equity Act: clinician awareness and impact on contraception provision","authors":"Aneesha Cheedalla ,&nbsp;Jessica K. Lee ,&nbsp;Anne E. Burke","doi":"10.1016/j.conx.2021.100071","DOIUrl":"10.1016/j.conx.2021.100071","url":null,"abstract":"<div><h3>Objective</h3><p>The Maryland Contraceptive Equity Act took effect in January 2018 with the goal of reducing insurance barriers to contraception. We sought to assess the Act's impact on contraceptive provision.</p></div><div><h3>Study Design</h3><p>From March-August 2019, we emailed an exploratory survey to clinicians providing contraception in Maryland that queried awareness of the Act and changing practices.</p></div><div><h3>Results</h3><p>The survey had a 13% response rate (164/1256 clinicians). Fifty (31%) were aware of the Act. Clinicians rated the Act was somewhat likely to change prescribing practices (3.5/5 point Likert Scale, SD 1.3).</p></div><div><h3>Conclusion</h3><p>The majority of clinicians providing contraception in Maryland are not aware of the Act. If aware of the Act, clinicians may change their contraceptive prescribing practices.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/29/main.PMC8790273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities","authors":"Hayley V. McMahon ,&nbsp;Celia Karp ,&nbsp;Suzanne O. Bell ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Linnea A. Zimmerman","doi":"10.1016/j.conx.2022.100087","DOIUrl":"10.1016/j.conx.2022.100087","url":null,"abstract":"<div><h3>Objectives</h3><p>Unsafe abortion is a leading cause of global maternal mortality and morbidity. This study sought to estimate availability of essential postabortion care (PAC) services among publicly managed health facilities in Ethiopia.</p></div><div><h3>Study design</h3><p>Data from public hospitals and health centers in Ethiopia were collected in 2020. Among facilities offering labor and delivery, we assessed the proportion that: (1) offered PAC, (2) were equipped for each PAC signal function, and (3) were equipped for all PAC signal functions falling within their scope of care by facility type.</p></div><div><h3>Analysis</h3><p>Our primary outcome was PAC service provision status. Descriptive statistics summarized the proportion of hospitals and health centers, respectively, categorized as each PAC status and with necessary equipment for individual signal functions. Per Federal Ministry of Health (FMOH) guidelines, hospitals are expected to provide comprehensive PAC, while health centers are expected to provide basic PAC.</p></div><div><h3>Results</h3><p>Altogether, 69.1% (<em>n</em> = 94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (<em>n</em> = 131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; <em>n</em> = 114) and uterine evacuation among health centers (84.6%; <em>n</em> = 170).</p></div><div><h3>Conclusion</h3><p>Meaningful progress has been made toward achieving the Ethiopian FMOH's goal of universal PAC service availability at hospitals and health centers by 2020. Despite this, sizable gaps remain and may endanger maternal health in Ethiopia, underscoring a need for continued prioritization of PAC services.</p></div><div><h3>Implications</h3><p>Ethiopia's commitment to PAC has fostered a service landscape that is stronger than many other low-resource settings; however, notable shortcomings are present. Further research is needed to understand the potential role of clinical training and supply-side interventions.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40495980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DMPA-SC stock: Cross-site trends by facility type","authors":"Sophia Magalona ,&nbsp;Shannon N. Wood ,&nbsp;Frederick Makumbi ,&nbsp;Funmilola M. OlaOlorun ,&nbsp;Elizabeth Omoluabi ,&nbsp;Akilimali Z. Pierre ,&nbsp;Georges Guiella ,&nbsp;Jane Cover ,&nbsp;Philip Anglewicz","doi":"10.1016/j.conx.2022.100075","DOIUrl":"10.1016/j.conx.2022.100075","url":null,"abstract":"<div><h3>Objectives</h3><p>To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods.</p></div><div><h3>Study design</h3><p>We used repeated cross-sectional data from service-delivery-point surveys in six settings: Burkina Faso, Democratic Republic of Congo (Kinshasa and Kongo Central), Nigeria (Kano and Lagos), and Uganda, each with 3-5 rounds of data collected between 2016 and 2020. We analyzed trends in DMPA-SC availability using percent of service delivery points offering the method and percent experiencing stockouts; trends were compared with those for DMPA-IM, IUD, implants, and other short-acting methods, by facility type.</p></div><div><h3>Results</h3><p>All settings showed increased offering of DMPA-SC over time for both private and public facilities. Larger proportions of public facilities provided DMPA-SC compared to private facilities (66%–97% vs 16%–50% by 2019–2020). DMPA-SC was provided by fewer facilities than DMPA-IM (90%–100% public, 34%–69% private by 2019–2020), but comparable to implants (83%–100% public, 15%–52% private by 2019–2020) and IUDs (55%–91% public, 0%–44% private by 2019–2020). Trends of DMPA-SC stock varied by setting, with more consistent stock available in private facilities in the DRC and in public facilities in Burkina Faso and Nigeria. Uganda showed decreasing stock in public facilities but increasing stock in private facilities.</p></div><div><h3>Conclusion</h3><p>DMPA-SC availability has been increasing since its introduction in sub-Saharan Africa, yet significant gaps in stock exist. Countries should consider alternative distribution models to address these issues.</p></div><div><h3>Implications</h3><p>Our findings may help inform countries about the need to monitor DMPA-SC availability and to consider solutions that ensure contraceptive options are available to women who need them and disruptions to contraceptive use are minimized.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151622000041/pdfft?md5=2b656ca268c0da1d394d1163166730ef&pid=1-s2.0-S2590151622000041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49395685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to ovulation after Sayana Press is injected every 4 months for one year: Empirical and pharmacokinetic/pharmacodynamic modeling results","authors":"Douglas J. Taylor ,&nbsp;Jennifer Deese ,&nbsp;Luis Bahamondes ,&nbsp;Vivian Brache ,&nbsp;Nelio Veiga Jr ,&nbsp;Rachael Fuchs ,&nbsp;Vera Halpern ,&nbsp;Laneta J. Dorflinger","doi":"10.1016/j.conx.2022.100080","DOIUrl":"10.1016/j.conx.2022.100080","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize return to ovulation after injecting Sayana Press (104 mg/0.65 mL medroxyprogesterone acetate [MPA] in the Uniject device) every 4 months for 1 year of treatment.</p></div><div><h3>Study design</h3><p>We followed a subset of women for return to ovulation in a trial that demonstrated Sayana Press remains highly effective when the subcutaneous reinjection interval is extended from 3 to 4 months. We measured serum progesterone in weeks 38 to 42 and 46 to 50 after a final (third) injection and used a concentration ≥4.7 ng/mL as a surrogate for ovulation. We also performed pharmacokinetic and pharmacodynamic modeling to predict differences in MPA accumulation and return to ovulation had - contrary to fact - injections been given every 3 months.</p></div><div><h3>Results</h3><p>Ten of 19 women (53%; 95% confidence interval: 29–76) ovulated within 50 weeks of their last injection. We predicted that typical 12-month trough MPA concentrations are 34% lower (0.46 vs 0.69 ng/mL) and the median time from last dose to ovulation is 1.1 months shorter (13.1 vs 14.2 months) when injections are given every four months for 1 year.</p></div><div><h3>Conclusion</h3><p>Extending the Sayana Press reinjection interval from 3 to 4 months leads to less drug accumulation, without a noticeable loss in efficacy. Although the Sayana Press patient leaflet specifies that over 80% of women desiring pregnancy will conceive within a year of stopping the method (independent of treatment duration), our empirical and modeling results indicate women should anticipate waiting a year or more for fertility to return after repeat dosing, with a somewhat shorter delay were the reinjection interval extended to four months.</p></div><div><h3>Implications</h3><p>Providers should counsel women regarding the distinct possibility that return to fertility will take a year or longer following repeat use of Sayana Press. Extending the dosing interval from 3 to 4 months would result in approximately a 1-month shorter delay, without any appreciable reduction in contraceptive efficacy.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/1d/main.PMC9372597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40697332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review","authors":"Abraham Fessehaye Sium ,&nbsp;Tesfaye H. Tufa ,&nbsp;Jaclyn M. Grentzer ,&nbsp;Sarah Prager","doi":"10.1016/j.conx.2022.100082","DOIUrl":"10.1016/j.conx.2022.100082","url":null,"abstract":"<div><h3>Background</h3><p>Current literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting.</p></div><div><h3>Methods</h3><p>This is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2^nd trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies.</p></div><div><h3>Results</h3><p>More than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%.</p></div><div><h3>Conclusion</h3><p>In this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies.</p></div><div><h3>Implications</h3><p>In an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33438190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia","authors":"Linnea A. Zimmerman ,&nbsp;Dana O. Sarnak ,&nbsp;Celia Karp ,&nbsp;Shannon N. Wood ,&nbsp;Mahari Yihdego ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme","doi":"10.1016/j.conx.2022.100074","DOIUrl":"10.1016/j.conx.2022.100074","url":null,"abstract":"<div><h3>Objective</h3><p>Our objectives were to assess the prevalence of specific side-effects experienced by current and recent contraceptive users, describe patterns of side-effects that users were concerned about, and share measurement lessons learned.</p></div><div><h3>Study design</h3><p>Data come from the PMA Ethiopia 2019 nationally-representative, cross-sectional survey. Our analytic sample included women who were current (weighted <em>n</em> = 2190; unweighted <em>n</em> = 2020) or recent (past 24 months; weighted <em>n</em> = 627; unweighted <em>n</em> = 622) users of a hormonal method or IUD. We provide descriptive statistics of the percentage of current/recent users who report currently/ever experiencing specific side-effects, not experiencing but being concerned about experiencing specific side-effects, and both currently experiencing and being concerned about experiencing specific side-effects. All analyses are stratified by method type (implant, injectable, pill) to explore variation by method.</p></div><div><h3>Results</h3><p>Among current users, 648/2190 women (30%) reported experiencing any side-effect, while 252/644 (40%) of recent users reported ever experiencing any side-effect. Bleeding changes were reported most frequently and were higher among implant and injectable users. More recent users reported side-effects that were associated with physical discomfort, such as headaches, than current users. About one-third of current and recent users reported being concerned about at least one side-effect that they had not experienced, with about 15% of current and recent users reporting concerns about bleeding changes (307/2190 and 112/627, respectively) and concerns about physical discomfort (334/2019 and 98/627, respectively).</p></div><div><h3>Conclusions</h3><p>While bleeding changes are common, users report a range of side-effects related to physical discomfort underscoring the need for comprehensive counseling. We highlight challenges in measuring side-effects using quantitative tools and pose recommendations for future research and measurement efforts.</p></div><div><h3>Implications</h3><p>: Experiencing and fearing contraceptive-induced menstrual bleeding changes and physical discomfort, particularly headaches, is high among hormonal contraceptive and IUD users in Ethiopia. counseling that addresses an array of side-effects is needed. Additional research is also needed to disentangle the effect of experiencing versus fearing side-effects on contraceptive use.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259015162200003X/pdfft?md5=a1575c2b208f96e47e59793cc006ec18&pid=1-s2.0-S259015162200003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47704154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas","authors":"Kristen Lagasse Burke ,&nbsp;Lauren Thaxton ,&nbsp;Joseph E. Potter","doi":"10.1016/j.conx.2020.100052","DOIUrl":"10.1016/j.conx.2020.100052","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas.</p></div><div><h3>Study design</h3><p>Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued.</p></div><div><h3>Results</h3><p>Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1–75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50–0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12–1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12–1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method.</p></div><div><h3>Conclusions</h3><p>Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable.</p></div><div><h3>Implications</h3><p>Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38861064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on pharmacy access to hormonal contraception among rural New Mexico women","authors":"Lauren Thaxton ,&nbsp;Elizabeth Clark ,&nbsp;Jocelyn Aubrey Wu ,&nbsp;Alexandra Herman ,&nbsp;Andrew L. Sussman ,&nbsp;Eve Espey","doi":"10.1016/j.conx.2021.100069","DOIUrl":"10.1016/j.conx.2021.100069","url":null,"abstract":"<div><h3>Objective</h3><p>In 2017, New Mexico approved an amendment allowing pharmacists to prescribe and dispense hormonal contraception. We interviewed rural New Mexico women to determine their perceptions of pharmacy access to hormonal contraception.</p></div><div><h3>Study design</h3><p>We conducted semi-structured telephone interviews with women recruited from rural New Mexico communities. The interview guide explained the amendment followed by questions about the advantages and disadvantages of pharmacy access to hormonal contraception within rural communities.</p></div><div><h3>Results</h3><p>Between November 2017 and May 2018, we recruited 32 women to participate. Participants were young (26/32 18–29 years old), gravid (27/31), employed (30/32), white (22/32) and Hispanic (26/31). The majority used Medicaid as their primary insurance (16/28). Most participants were supportive of pharmacy access to hormonal contraception. Participants saw their rural communities as facing health care barriers, some of which could be alleviated by pharmacy access. Perceived benefits of pharmacy access included convenience of pharmacy hours, shorter wait times, and no need for an appointment. Participants expressed concerns about lack of privacy in their pharmacies. Many expressed trust in their pharmacist to review side effects and explain usage of contraception- a role that was considered separate from that of a primary care provider who offers regular medical visits for routine screening and nuanced or complex discussions about contraception. Some participants expressed that pharmacy access could be especially beneficial for teens.</p></div><div><h3>Conclusions</h3><p>Rural New Mexico women were supportive of pharmacy access to contraception and accept pharmacists as trusted members of the health care team.</p></div><div><h3>Implications</h3><p>Rural New Mexico women find benefit in pharmacy access to hormonal contraception, citing improved access to contraceptives in their communities.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39344100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral sedation for pain with cervical dilator placement: a randomized controlled trial","authors":"Jessica K. Lee ,&nbsp;Anne E. Burke ,&nbsp;Katrina Thaler ,&nbsp;Jennifer A. Robinson ,&nbsp;Carolyn Sufrin","doi":"10.1016/j.conx.2020.100053","DOIUrl":"10.1016/j.conx.2020.100053","url":null,"abstract":"<div><h3>Objective</h3><p>Assess oral sedation versus placebo for pain control with cervical dilator placement.</p></div><div><h3>Study design</h3><p>We randomized participants presenting for dilation and evacuation to lorazepam 1 mg/oxycodone 5 mg or placebo 45 min before cervical dilator placement. Our primary outcome was median visual analog scale (VAS) pain score after dilator placement using a 100-mm VAS. We used our outcome data to calculate median pain score changes from baseline to better reflect pain score differences between study groups. Planned sample size was 30 participants per group, for a total of 60.</p></div><div><h3>Results</h3><p>We randomized 27 participants; 9 received sedation and 11 placebo. Median pain score increase from baseline to last dilator placement was 20 [interquartile range (IQR) 8–29] and 31 (IQR 15–81) in the oral sedation and placebo groups, p = .16.</p></div><div><h3>Conclusion</h3><p>We were unable to enroll our desired sample size, and our sample is underpowered to make any conclusions. Our results suggest that oral sedation may provide some benefit for pain relief with dilator insertion and indicate that further research might be worthwhile especially in settings that do not routinely provide these analgesics.</p></div><div><h3>Implications</h3><p>We had difficulty with study recruitment because many patients desired oral sedation for pain management for cervical dilator placement and declined randomization. Randomized trials of pain management with a placebo arm may find recruitment challenging especially if default clinical care already includes a pain management option that patients would have to opt out of.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38869164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in use of emergency contraceptive pills in the United States from 2008 to 2015","authors":"Rubina Hussain,&nbsp;Megan L. Kavanaugh","doi":"10.1016/j.conx.2021.100065","DOIUrl":"10.1016/j.conx.2021.100065","url":null,"abstract":"<div><h3>Objectives</h3><p>To describe changes in use and receipt of emergency contraceptive (EC) pills among women in the United States during a period of key EC policy changes, from 2008 to 2015.</p></div><div><h3>Study design</h3><p>Using data from the 2006 to 2010 and 2013 to 2017 National Surveys of Family Growth, we present changes in the percent of women who ever used EC between 2008 and 2015 by select sociodemographic and sexual and reproductive health characteristics, and we examine multivariable relationships of these characteristics with EC ever use in 2015. We also examine changes in repeat EC use, receipt of EC counseling, reasons for EC use and source of EC between the time periods.</p></div><div><h3>Results</h3><p>Among sexually experienced women ages 15 to 44, EC ever use increased from 11% in 2008 to 23% in 2015 overall and among nearly all groups of women. In 2015, age 20 to 29, non-Hispanic other or Hispanic race, at least a high school education, working part-time, income at least 100% of the federal poverty level, ever having been married, and having received EC counseling in the prior year all represent characteristics associated with higher odds of having ever used EC. In 2015, a smaller share of women last obtained EC with a prescription or at a health facility than in 2008.</p></div><div><h3>Conclusions</h3><p>Increases in EC use occurred as access to EC was broadened through regulatory changes that moved some forms of EC from behind-the-counter to fully over-the-counter between 2008 and 2015.</p></div><div><h3>Implications</h3><p>Over-the-counter provision of many forms of EC pills may have increased access and introduced more flexibility in how EC is obtained, but these changes may have come with tradeoffs, both in the form of cost barriers and decreased opportunities for clinicians to discuss EC with their patients. Despite improved access to contraception more broadly through the Affordable Care Act, EC remains a necessary component of the overall contraceptive method mix, and clinicians can play a key role in discussing EC as one option among many during contraceptive counseling sessions.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39238762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}